Small cell lung cancer. Serial bronchofiberscopy and photographic documentation--the bridge sign

To determine whether serial bronchofiberscopy provides better assessment of remission and relapse in chemotherapy and radiotherapy for small cell lung cancer, therapy was preceded by bronchofiberscopy with a new, high-resolution system for photographic documentation and either open-tube of bronchofiberscopic histocytologic diagnosis. Four-course cytostatic induction therapy was combined with prophylactic brain irradiation and irradiation of primary disease sites. Bronchofiberscopy was repeated after induction chemotherapy (in some cases combined with consolidating radiotherapy) and following complete remission (CR) if relapse was suspected. Sixty patients with limited-stage disease underwent a total of 152 bronchoscopies. Eight (16 percent) of those thought to be in CR by clinical, radiologic, and tumor-marker data were histocytologically tumor-positive on endoscopy. Of ten patients thought later to have had relapse following CR, four were endoscopically tumor-positive. The bridge sign is described as a further endoscopic indicator of CR. Consecutive outpatient endoscopic examinations were well tolerated, without complications. In treatment of small cell lung cancer, routine serial bronchofiberscopy is feasible and useful. It substantiates definition of CR, lowering the risk of early relapse. By better identifying the partial responder, it contributes to a rational approach for subsequent management. Finally, it enables early endoscopic detection of local recurrence in selected cases.